NLA releases draft recommendations for dyslipidemia management

Issue: July 2015

CHICAGO — The National Lipid Association has announced the release of a draft of new recommendations for cholesterol management in diverse ethnic and racial groups and for all age groups, from children to seniors.

From now until June 25, Part Two of the NLA Recommendations for Patient-Centered Management of Dyslipidemia are available on the NLA website for public comment.

The new guidance focuses on three major categories: lifestyle therapies, groups with special considerations and improving patient outcomes. Specific groups with special considerations include children and adolescents; women; older adults; African Americans, Hispanics and South Asians; patients with other high-risk conditions such as HIV or rheumatologic diseases; and patients with residual risk despite statin and lifestyle therapy.

“We realize there are several groups that have been under-addressed,” Terry A. Jacobson, MD, NLA president and professor of medicine at Emory University, said during the NLA Scientific Sessions.

Part Two of the recommendations reinforces the importance of lifestyle change as the cornerstone of therapy. The panel of independent experts provide guidance on specific changes in diet, dietary patterns, and the amount of physical activity and exercise required for optimal CV health, according to a press release.

“NLA is deeply committed to lifestyle therapies,” Jacobson said during his presentation.

Several highlights include:

Dietary patterns should be individualized based on the patient’s lipid/lipoprotein profile. The DASH diet, the USDA Food Pattern, the American Heart Association diet, a Mediterranean diet and vegetarian/vegan diets are recommended.
To reduce triglycerides and modestly raise HDL, patients should exercise at least 5 days per week at 40% to 75% aerobic capacity.
After lifestyle therapy, statins remain the first-line therapy for patients with high-risk conditions, including HIV and rheumatoid arthritis, and those at risk based on ethnicity or race.
Increased rates of obesity, metabolic syndrome and diabetes in ethnic and racial minorities is of great concern, and aggressive efforts in lifestyle control are needed.
Universal lipid screening of all children, regardless of general health or atherosclerotic CVD risk factors, is recommended at age 9 to 11 years, with repeat lipid screening at age 20 years, or earlier if dyslipidemia is present.
At each patient visit, medication adherence should be discussed to identify problems, barriers or side effects. Patients should also receive continuous feedback about their cholesterol levels and goals.
Use of an interdisciplinary team of health care providers, including nurses, nurse practitioners, clinical pharmacists, physician assistants and registered dietitian nutritionists, should be used to assist patients with adherence issues.
For high-risk patients not at their cholesterol goal while on a maximally tolerated statin dose, consideration should be given to adding nonstatin lipid-altering therapies for further lowering of atherogenic cholesterol.

“The NLA Part Two recommendations build on our previous NLA Part One recommendations. We are excited to provide a comprehensive set of recommendations in the management of atherogenic cholesterol that may aid clinicians and patients in making better clinical decisions using a patient centered approach,” Jacobson stated in the release.

Slides of Part Two of the NLA Recommendations are available in draft form on the NLA website, with a 2-week public comment period starting on June 11. The final version of Part Two is scheduled for publication in the Journal of Clinical Lipidology later in 2015 after the consideration of comments, according to the release. – by Katie Kalvaitis

Reference:

Jacobson TA. NLA Recommendations for Management of Special Populations – Part 2. Presented at: National Lipid Association Scientific Sessions; June 11-14, 2015; Chicago.

Disclosure: Jacobson is president of the NLA and chair of the NLA expert panel writing committee.